Multiparametric MRI: Local Staging of Prostate Cancer
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GERIATRICS (G GUGLIELMI, SECTION EDITOR)
Multiparametric MRI: Local Staging of Prostate Cancer F. A. Carpagnano1,2 • L. Eusebi3 • U. Tupputi1,2 • V. Testini1,2 • W. Giannubilo4 F. Bartelli3 • G. Guglielmi1,2,5
•
Accepted: 27 October 2020 Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To highlight the recent evidence about the use of mp-MRI in the local staging of prostate cancer, enhancing the potential benefits compared to the known and more invasive canonical staging methods. Recent Findings Multiparametric magnetic resonance (mp-MRI) plays a key role not only in diagnosis, but also in local staging of prostate cancer, as it can assess with high accuracy the extracapsular extension of the tumor, invasion of seminal vesicles, the involvement of lymph nodes and the presence of possible bone metastases. Summary Prostate cancer is currently the most common male cancer in Europe and it is associated with a high mortality rate, which is why it is necessary to make an early and accurate diagnosis. Firstly, it is important to distinguish between a disease confined to the gland and a disease with a loco regional or remote extension, since neoplastic staging is the starting point for risk stratification, prognosis and therapeutic planning. According to the PIRADS guidelines v 2.1 the main mp-MRI sequences
This article is part of the Topical Collection on Geriatrics. & G. Guglielmi [email protected]; http://www.unifg.it 1
Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Viale L. Pinto 1, 71121 Foggia, Italy
2
Radiology Unit, ‘‘Dimiccoli’’ Hospital, Barletta, Italy
3
Radiology Unit, ‘‘Carlo Urbani’’ Hospital, Jesi, Italy
4
Urology Unit, ‘‘Carlo Urbani’’ Hospital, Jesi, Italy
5
Radiology Unit, Hospital ‘‘Casa Sollievo Della Sofferenza’’, San Giovanni Rotondo, Foggia, Italy
necessary to obtain a complete and accurate resonance imaging are the T2-weighted sequences (T2WI), which represent the pivotal morphological sequences for local staging, together with the diffusion-weighted imaging (DWI) and dynamic sequences acquired after intravenous contrast medium administration (DCE). However, due to some limitations, mp-MRI does not have the same diagnostic power in the evaluation of lymph nodes, for which the gold standard remains the extended pelvic nodal dissection (ePLND), nor in the detection of distant metastases. For this last aspect, the next generation imaging foresees the use of whole-body MRI (WB-MRI), especially for the high accuracy in the early detection of local and remote bone metastases. Keywords Prostate cancer Mp-MRI TNM staging Local staging
Introduction Prostate cancer is the most common male cancer in Europe, excluding skin cancer, with a higher incidence in Northern and Western European countries ([ 200 per 100,000 men/ year) and an equally high mortality rate [1, 2]. Prevalence in certain geographical areas, rather than in others, suggests the pres
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